The document discusses essential elements of normal newborn care including clean delivery and cord care, thermal protection, early and exclusive breastfeeding, monitoring, eye care, and immunization. It notes that major causes of newborn deaths are birth asphyxia, infections, prematurity, and hypothermia. Studies evaluated different prophylactic options for preventing ophthalmia neonatorum and found povidone-iodine and silver nitrate to be effective. The summary emphasizes establishing clean practices, thermal regulation, breastfeeding support and providing basic medical care for newborns.

1. Normal Newborn Care
Advances in Maternal and Neonatal Health

2. 2
Normal Newborn Care
Session Objective
 Define essential elements of early newborn care
 Discuss best practices and technologies for promoting
newborn health
 Use relevant data and information to develop appropriate
essential newborn recommendations

3. 3
Normal Newborn Care
Newborn Deaths
 8.1 million infant deaths
(1993)
 3.9 million (48%) newborn
deaths
 2.8 million (67%) early
newborn deaths
 Major causes of newborn
deaths
 Birth asphyxia: 21%
 Infections: 42% (tetanus,
sepsis, meningitis,
pneumonia, diarrhea)

4. 4
Normal Newborn Care
Newborn Deaths (continued)
 Birth process was the antecedent cause of 2/3 of deaths due to
infections
 Lack of hygiene at childbirth and during newborn period
 Home deliveries without skilled birth attendants
 Birth asphyxia in developing countries
 3% of newborns suffer mild to moderate birth asphyxia
 Prompt resuscitation is often not initiated or procedure is
inadequate or incorrect

5. 5
Normal Newborn Care
Newborn Deaths (continued)
 Hypothermia and newborn deaths
 Significant contribution to deaths in low birth weight
infants and preterm newborns
 Social, cultural and health practices delaying care to the
newborn
 Countries with high STD prevalence and inconsistent
prophylactic practices
 Ophthalmia neonatorum is a common cause of blindness

6. 6
Normal Newborn Care
Newborn Deaths (continued)
 Low birth weight
 An extremely important factor in newborn mortality
 Place of childbirth
 At least 2 out 3 childbirths in developing countries occur at
home
 Only half are attended by skilled birth attendants
 Strategies for improving newborn health should target
– Birth attendant, families and communities
– Healthcare providers within the formal health system

7. 7
Normal Newborn Care
Essential Newborn Care Interventions
 Clean childbirth and cord care
 Prevent newborn infection
 Thermal protection
 Prevent and manage newborn hypo/hyperthermia
 Early and exclusive breastfeeding
 Started within 1 hour after childbirth
 Initiation of breathing and resuscitation
 Early asphyxia identification and management

8. 8
Normal Newborn Care
Essential Newborn Care
Interventions (continued)
 Eye care
 Prevent and manage ophthalmia neonatorum
 Immunization
 At birth: bacille Calmette-Guerin (BCG) vaccine, oral
poliovirus vaccine (OPV) and hepatitis B virus (HBV)
vaccine (WHO)
 Identification and management of sick newborn
 Care of preterm and/or low birth weight newborn

9. 9
Normal Newborn Care
Cleanliness to Prevent Infection
 Principles of cleanliness essential in both home and health
facilities childbirths
 Principles of cleanliness at childbirth
 Clean hands
 Clean perineum
 Nothing unclean introduced vaginally
 Clean delivery surface
 Cleanliness in cord clamping and cutting
 Cleanliness for cord care
 Infection prevention/control measures at healthcare facilities

10. 10
Normal Newborn Care
Thermal Protection
 Newborn physiology
 Normal temperature: 36.5–37.5°C
 Hypothermia: < 36.5°C
 Stabilization period: 1st 6–12 hours after birth
– Large surface area
– Poor thermal insulation
– Small body mass to produce and conserve heat
– Inability to change posture or adjust clothing to
respond to thermal stress
 Increase hypothermia
 Newborn left wet while waiting for delivery of placenta
 Early bathing of newborn (within 24 hours)

11. 11
Normal Newborn Care
Hypothermia Prevention
 Deliver in a warm room
 Dry newborn thoroughly and wrap in dry, warm cloth
 Keep out of draft and place on a warm surface
 Give to mother as soon as possible
 Skin-to-skin contact first few hours after childbirth
 Promotes bonding
 Enables early breastfeeding
 Check warmth by feeling newborn’s feet every 15 minutes
 Bathe when temperature is stable (after 24 hours)

12. 12
Normal Newborn Care
Early and Exclusive Breastfeeding
 Early contact between mother and newborn
 Enables breastfeeding
 Rooming-in policies in health facilities prevents
nosocomial infection
 Best practices
 No prelacteal feeds or other supplement
 Giving first breastfeed within one hour of birth
 Correct positioning to enable good attachment of the
newborn
 Breastfeeding on demand
 Psycho-social support to breastfeeding mother
WHO 1999.

13. 13
Normal Newborn Care
Breathing Initiation and Resuscitation
 Spontaneous breathing (> 30 breaths/min.) in most newborns
 Gentle stimulation, if at all
 Effectiveness of routine oro-nasal suctioning is unknown
 Biologically plausible advantages – clear airway
 Potentially real disadvantages – cardiac arrhythmia
 Bulb suctioning preferred
 Newborn resuscitation may be needed
 Fetal distress
 Thick meconium staining
 Vaginal breech deliveries
 Preterm
Hamilton 1999.

14. 14
Normal Newborn Care
Eye Care To Prevent or Manage
Ophthalmia Neonatorum
 Ophthalmia neonatorum
 Conjunctivitis with discharge during first 2 weeks of life
 Appears usually 2–5 days after birth
 Corneal damage if untreated
 Systemic progression if not managed
 Etiology
 N. gonorrhea
– More severe and rapid development of complications
– 30–50% mother-newborn transmission rate
 C. trachomatis

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Normal Newborn Care
Eye Care To Prevent or Manage
Ophthalmia Neonatorum (continued)
 Prophylaxis
 Clean eyes immediately
 1% Silver nitrate solution
– Not effective for chlamydia
 2.5% Povidone-iodine solution
 1% Tetracycline ointment
– Not effective vs. some N. gonorrhea strains
 Common causes of prophylaxis failure
 Giving prophylaxis after first hour
 Flushing of eyes after silver nitrate application
 Using old prophylactic solutions

16. 16
Normal Newborn Care
Efficacy of Prophylaxis for
Conjunctivitis in China
 Objective: To assess etiology of newborn conjunctivitis and
evaluate the efficacy of regimens in China
 Design: November 1989 to October 1991 rotated regimens
monthly: tetracycline, erythromycin, silver nitrate
 302 (6.7%) infants developed conjunctivitis, most S. aureus
(26.2%) and chlamydia (22.5%)
 Silver nitrate, tetracycline: fewer cases than no prophylaxis (p
< 0.05), erythromycin: not significant
Chen 1992.

17. 17
Normal Newborn Care
Prophylaxis for Conjunctivitis: Objective
and Design
 Objective: To compare efficacy in prevention of
nongonococcal conjunctivitis
 Design: Randomized control trial to compare erythromycin,
silver nitrate, no prophylaxis
 Examined with test for leukocyte esterase and chlamydia
trachomatis antibody probe 30–48 hours postpartum, 13–15
days later, and telephone contact up to 60 days of life
 Main outcome measured: conjunctivitis within 60 days of life
and nasolacrimal duct patency
Bell 1993.

18. 18
Normal Newborn Care
Prophylaxis for Conjunctivitis:
Results and Conclusion
 Results: 630 infants
 109 with conjunctivitis
 Silver nitrate vs. no prophylaxis: Hazard ratio 0.61 (0.39-
0.97)
– Chemical conjunctivitis with silver nitrate resolves
within 48 hours
 Erythromycin vs. no prophylaxis: Hazard ratio 0.69 (not
significant)
 Conclusion: Parental choice of prophylaxis, including no
prophylaxis, is reasonable IF antenatal care and STD screening
Bell 1993.

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Normal Newborn Care
Povidone-Iodine for Conjunctivitis:
Objective and Design
 Objective: To determine incidence and type of conjunctivitis
after povidone-iodine in Kenya
 Design: Rotate regimen weekly: erythromycin, silver nitrate,
povidone iodine
 Results:
 Conjunctivitis:
– Chlamydia in 50.5%
– S. aureus in 39.7%
 More infections in silver nitrate than povidone-iodine, OR
1.76, p < 0.001
 More infections in erythromycin OR 1.38, p=0.001
Isenberg, Apt and Wood 1995.

20. 20
Normal Newborn Care
Povidone-Iodine for Conjunctivitis:
Conclusion
Povidone-iodine:
 Is good prophylaxis
 Has wider antibacterial spectrum
 Causes greater reduction in colony-forming units and
number of bacterial species
 Is active against viruses
 Is inexpensive
Isenberg, Apt and Wood 1995.

21. 21
Normal Newborn Care
Immunization
 BCG vaccinations in all population at high risk of tuberculosis
infection
 Single dose of OPV at birth or in the two weeks after birth
 HBV vaccination as soon as possible where perinatal
infections are common

22. 22
Normal Newborn Care
Summary
The essential components of normal newborn care include:
 Clean delivery and cord care
 Thermal protection
 Early and exclusive breastfeeding
 Monitoring
 Eye care
 Immunization

23. 23
Normal Newborn Care
References
Bell TA et al. 1993. Randomized trial of silver nitrate, erythromycin and no
eye prophylaxis for the prevention of conjunctivitis among newborns not
at risk for gonococcal ophthalmitis. Pediatrics 92: 755–760.
Chen J. 1992. Prophylaxis of ophthalmia neonatorum: comparison of
silver nitrate, tetracycline, erythromycin, and no prophylaxis. Pediatr
Infect Dis J 11: 1026–1030.
Child Health Research Project and Maternal and Neonatal Health Program.
1999. Reducing Perinatal and Neonatal Mortality. Report of a meeting in
Baltimore, Maryland, 10–12 May, 1999.
Hamilton P. 1999. Care of the newborn in the delivery room. Br Med J 318:
1403–1406.
Isenberg SJ, L Apt and M Wood. 1995. A controlled trial of povidone-
iodine as prophylaxis against ophthalmitis neonatorum. N Engl J Med 332:
562–566.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical
Guide. WHO: Geneva.